Post-Circumcision Urethro-Cutaneous Fistula: The Key to Successful Reconstruction.

Background: Routine circumcision of boys is a common practice in Tanzania. Because sometimes it is performed by persons with no surgical training, complications, including urethro-cutaneous fistula (UCF), are not uncommon.Methods: Five boys whose ages ranged between 4 and 12 years with UCF were seen at four Dar es Salaam hospitals between 2002 and 2005. Personal particulars, the personnel doing the circumcision, description of the repair and follow up were recorded on a data sheet. Intravenous Augmentin was given at induction of anaesthesia for the fistula repair. A urethral catheter was inserted, and then a tourniquet was applied at the base of the penis. After incision and development of skin flaps the urethra was closed, a layer of dartos fascia interposed, followed by closure of the skin, all with 6/0 Vicryl. A compression dressing was applied, and the catheter was left in for 5-7 days.Results: The boys ranged in age between 5 and 12 years, and had undergone circumcision at age 2 to 12 years. All patients were circumcised by paramedical personnel or a traditional practitioner. Urine leakage commenced 2 days to 2 weeks after circumcision. Four boys had coronal while one had a glandular UCF. No post repair complication was reported after follow up of 3 to 20 weeks.Conclusion: Use of fine synthetic absorbable sutures and careful closure of the fistula with interposition of a pedicles dartos graft, are the main prerequisites for success. Attention to details of surgical technique can produce consistently good results in repair of UCF

Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group

In this Policy Forum, the Bellagio Essential Surgery Group, which was formed to advocate for increased access to surgery in Africa, recommends four priority areas for national and international agencies to target in order to address the surgical burden of disease in sub-Saharan Africa

Post-circumcision urethro-cutaneous fistula: the key to successful reconstruction.

Background: Routine circumcision of boys is a common practice in Tanzania. Because sometimes it is performed by persons with no surgical training, complications, including urethro-cutaneous fistula (UCF), are not uncommon. Methods: Five boys whose ages ranged between 4 and 12 years with UCF were seen at four Dar es Salaam hospitals between 2002 and 2005. Personal particulars, the personnel doing the circumcision, description of the repair and follow up were recorded on a data sheet. Intravenous Augmentin was given at induction of anaesthesia for the fistula repair. A urethral catheter was inserted, and then a tourniquet was applied at the base of the penis. After incision and development of skin flaps the urethra was closed, a layer of dartos fascia interposed, followed by closure of the skin, all with 6/0 Vicryl. A compression dressing was applied, and the catheter was left in for 5-7 days. Results: The boys ranged in age between 5 and 12 years, and had undergone circumcision at age 2 to 12 years. All patients were circumcised by paramedical personnel or a traditional practitioner. Urine leakage commenced 2 days to 2 weeks after circumcision. Four boys had coronal while one had a glandular UCF. No post repair complication was reported after follow up of 3 to 20 weeks. Conclusion: Use of fine synthetic absorbable sutures and careful closure of the fistula with interposition of a pedicles dartos graft, are the main prerequisites for success. Attention to details of surgical technique can produce consistently good results in repair of UCF

Sutured and open clean-contaminated and contaminated laparotomy wounds at Muhimbili National Hospital: A comparison Of complications.

Background: Whether to close or leave open an abdominal incision wound depends on the degree of wound contamination at the end of operation. The aim of this study was to compare the complication rates between delayed primary closure and primarily closed laparotomy wounds for clean-contaminated and contaminated abdominal operations. Methods: Eighty-six patients undergoing laparotomy were included in a randomized clinical trial. Patients were randomized to have their wounds left open or closed primarily. In this study, all patients received Ceftriaxone Sodium (Powercef ®) as a prophylactic antibiotic at the time of induction of anaesthesia. Results: There was a statistically significant difference (p=0.002) in wound infection rate between those wounds left open (30.2%) and those closed primarily (2.1%). It required a longer duration of time for dressing those wounds left open compared to those closed primarily, The average duration for wound dressing was 16 days for open wounds compared to 11 days for primarily closed ones (p=0.0002). There was no significant difference in the development of wound dehiscence between the two groups (p>0.05). No death was related to wound complication. Conclusion: Clean-contaminated and contaminated laparotomy wounds should be closed primarily if no gross spillage of visceral contents occurs during operation and a patient receives prophylactic antibiotics

Surgical wound infection in clean-contaminated and contaminated laparotomy wounds at Muhimbili National Hospital.

Background: Surgical wound (site) infection is the commonest complication following laparotomy for clean-contaminated and contaminated abdominal operations. Good surgical technique and perioperative prophylactic antibiotics in clean-contaminated and contaminated abdominal operations contribute to the low rate of surgical wound infection and its complications. The objectives of this study were to determine the prevalence and complications of surgical wound infection following laparotomy for clean-contaminated and contaminated abdominal operations at Muhimbili National Hospital. Methods: This was a prospective descriptive study done over a period of nine months from January 2001. The study population included patients assessed to have clean-contaminated and contaminated laparotomy wounds Results: The study revealed that surgical wound infection was the commonest complication accounting for 15.6%. Other complications include mortality rate of 8.9% and wound dehiscence (1.1%). Conclusion: It was concluded that another study is required in order to determine the cost of surgical wound infection in this hospital that is in transition towards cost-sharing and health management reform. Also, a long follow up study is required to determine the prevalence of incisional hernia in these wounds